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Transient Erythroblastopenia of Childhood

  • Author: Lennox H Huang, MD, FAAP; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
 
Updated: Mar 20, 2014
 

Background

Transient erythroblastopenia of childhood (TEC) is a slowly developing anemia that occurs in early childhood and is characterized by a gradual onset of pallor. As the name suggests, all patients with transient erythroblastopenia of childhood recover completely without sequelae.

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Pathophysiology

The etiology of transient erythroblastopenia of childhood is unknown. However, researchers have proposed numerous viral and immunologic mechanisms. At least 2 separate case reports have noted pure red cell aplasia with concomitant human parvovirus B19 infection.[1, 2] However, a prospective case series of 10 patients failed to identify a single viral causative agent for transient erythroblastopenia of childhood.[3]

In vitro studies using serum and immunoglobulin G (IgG) from some patients with transient erythroblastopenia of childhood demonstrated erythroid colony suppression, suggesting an immunologic etiology. Transient erythroblastopenia of childhood is not caused by a lack of erythropoietin. Bone marrow from patients with transient erythroblastopenia of childhood exhibits an absence of red cell precursors.

A recent case report of half siblings with transient erythroblastopenia of childhood and the accompanying literature review suggests that predisposition to transient erythroblastopenia of childhood may be autosomal dominant in nature.[4]

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Epidemiology

Frequency

United States

Attempts to determine frequency of transient erythroblastopenia of childhood are limited by an unknown number of asymptomatic undiagnosed cases.

Mortality/Morbidity

Morbidity relates to the severity of the anemia and diagnostic workup. Children with transient erythroblastopenia of childhood have reportedly presented with high-output shock secondary to profound anemia.[5] Patients with atypical transient erythroblastopenia of childhood may require invasive tests such as bone marrow aspiration or biopsy. Association of transient neurologic deficits may lead the physician to pursue CNS imaging studies or a neurologic consultation.

Sex

The male-to-female ratio is 1.4:1.

Age

The median age of presentation is 18-26 months; however, the disorder may occur in infants younger than 6 months and in children as old as 10 years. In contrast, Diamond-Blackfan anemia tends to present in child younger than 1 year, whereas human parvovirus B19–associated erythroblastopenia typically presents at an older age.

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Contributor Information and Disclosures
Author

Lennox H Huang, MD, FAAP Associate Professor and Chair, Department of Pediatrics, McMaster University School of Medicine; Chief of Pediatrics, McMaster Children's Hospital

Lennox H Huang, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Physician Leadership, Canadian Medical Association, Ontario Medical Association, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Robin Miller 

Disclosure: Nothing to disclose.

Carol Portwine, MD, PhD FRCP, FAAP, Associate Professor, Department of Pediatrics, Division of Hematology/Oncology, McMaster University

Carol Portwine, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, Canadian Medical Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Paediatric Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

James L Harper, MD Associate Professor, Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplantation, Associate Chairman for Education, Department of Pediatrics, University of Nebraska Medical Center; Associate Clinical Professor, Department of Pediatrics, Creighton University School of Medicine; Director, Continuing Medical Education, Children's Memorial Hospital; Pediatric Director, Nebraska Regional Hemophilia Treatment Center

James L Harper, MD is a member of the following medical societies: American Society of Pediatric Hematology/Oncology, American Federation for Clinical Research, Council on Medical Student Education in Pediatrics, Hemophilia and Thrombosis Research Society, American Academy of Pediatrics, American Association for Cancer Research, American Society of Hematology

Disclosure: Nothing to disclose.

Chief Editor

Max J Coppes, MD, PhD, MBA Executive Vice President, Chief Medical and Academic Officer, Renown Heath

Max J Coppes, MD, PhD, MBA is a member of the following medical societies: American College of Healthcare Executives, American Society of Pediatric Hematology/Oncology, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Sharada A Sarnaik, MBBS Professor of Pediatrics, Wayne State University School of Medicine; Director, Sickle Cell Center, Associate Hematologist/Oncologist, Children's Hospital of Michigan

Sharada A Sarnaik, MBBS is a member of the following medical societies: American Society of Hematology, American Society of Pediatric Hematology/Oncology, New York Academy of Sciences, Society for Pediatric Research, Children's Oncology Group, American Academy of Pediatrics, Midwest Society for Pediatric Research

Disclosure: Nothing to disclose.

References
  1. Prassouli A, Papadakis V, Tsakris A, et al. Classic transient erythroblastopenia of childhood with human parvovirus B19 genome detection in the blood and bone marrow. J Pediatr Hematol Oncol. 2005 Jun. 27(6):333-6. [Medline].

  2. Geetha D, Zachary JB, Baldado HM, et al. Pure red cell aplasia caused by Parvovirus B19 infection in solid organ transplant recipients: a case report and review of literature. Clin Transplant. 2000 Dec. 14(6):586-91. [Medline].

  3. Skeppner G, Kreuger A, Elinder G. Transient erythroblastopenia of childhood: prospective study of 10patients with special reference to viral infections. J Pediatr Hematol Oncol. 2002 May. 24(4):294-8. [Medline].

  4. Shaw J, Meeder R. Transient erythroblastopenia of childhood in siblings: case report and review of the literature. J Pediatr Hematol Oncol. 2007 Sep. 29(9):659-60. [Medline].

  5. Chabali R. Transient erythroblastopenia of childhood presenting with shock and metabolic acidosis. Pediatr Emerg Care. 1994 Oct. 10(5):278-80. [Medline].

  6. Schinasi DA, Schapiro E, Shah M. Ectopic atrial tachycardia in an infant with transient erythroblastopenia of childhood. Pediatr Emerg Care. 2011 Jul. 27(7):657-9. [Medline].

  7. Schinasi DA, Schapiro E, Shah M. Ectopic atrial tachycardia in an infant with transient erythroblastopenia of childhood. Pediatr Emerg Care. 2011 Jul. 27(7):657-9. [Medline].

  8. Ergül Y, Nisli K, Kelesoglu F, Dindar A. Acute pericarditis and transient erythroblastopenia associated with human parvovirus B19 infection. Turk Kardiyol Dern Ars. 2010 Jul. 38(5):349-51. [Medline].

  9. Moritake H, Hidaka F, Kamimura S, Kojima H, Shimonodan H, Nunoi H. Concomitant transient erythroblastopenia of childhood with neonatal hepatitis. Pediatr Int. 2012 Feb. 54(1):147-50. [Medline].

  10. Martinez Barrio A, Eriksson O, Badhai J, et al. Targeted resequencing and analysis of the Diamond-Blackfan anemia disease locus RPS19. PLoS One. 2009 Jul 9. 4(7):e6172. [Medline]. [Full Text].

  11. Chan GC, Kanwar VS, Wilimas J. Transient erythroblastopenia of childhood associated with transient neurologic deficit: report of a case and review of the literature. J Paediatr Child Health. 1998 Jun. 34(3):299-301. [Medline].

  12. Cherrick I, Karayalcin G, Lanzkowsky P. Transient erythroblastopenia of childhood. Prospective study of fifty patients. Am J Pediatr Hematol Oncol. 1994 Nov. 16(4):320-4. [Medline].

  13. Freedman MH. Recurrent' erythroblastopenia of childhood. An IgM-mediated RBC aplasia. Am J Dis Child. 1983 May. 137(5):458-60. [Medline].

  14. Gussetis ES, Peristeri J, Kitra V, et al. Clinical value of bone marrow cultures in childhood pure red cell aplasia. J Pediatr Hematol Oncol. 1998 Mar-Apr. 20(2):120-4. [Medline].

  15. Gustavsson P, Klar J, Matsson H, et al. Familial transient erythroblastopenia of childhood is associated with thechromosome 19q13.2 region but not caused by mutations in coding sequencesof the ribosomal protein S19 (RPS19) gene. Br J Haematol. 2002 Oct. 119(1):261-4. [Medline].

  16. Krijanovski OI, Sieff CA. Diamond-Blackfan anemia. Hematol Oncol Clin North Am. 1997 Dec. 11(6):1061-77. [Medline].

  17. Miller R, Berman B. Transient erythroblastopenia of childhood in infants < 6 months of age. Am J Pediatr Hematol Oncol. 1994 Aug. 16(3):246-8. [Medline].

  18. Mupanomunda OK, Alter BP. Transient erythroblastopenia of childhood (TEC) presenting as leukoerythroblastic anemia. J Pediatr Hematol Oncol. 1997 Mar-Apr. 19(2):165-7. [Medline].

  19. Tam DA, Rash FC. Breath-holding spells in a patient with transient erythroblastopenia of childhood. J Pediatr. 1997 Apr. 130(4):651-3. [Medline].

  20. Walters MC, Abelson HT. Interpretation of the complete blood count. Pediatr Clin North Am. 1996 Jun. 43(3):599-622. [Medline].

 
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